Experiment No.

15
OBJECT: To prepare the SOAP notes for given clinical case of dermatological conditions.
REFERENCE: Singh Harpreet, Mishra A.K, Chaudhary V.K, Laboratory Manual of
Pharmacotherapeutics, Everest Publishing House, 1st Edition 2023, Page No. 78-83.
Theory: Skin diseases are illnesses that affect the surface of the skin. Rashes, inflammation,
itching, and other skin changes may be caused by these diseases. Some skin conditions are caused
by genetics, while others are caused by lifestyle factors. Medications, creams, and ointments, as
well as lifestyle changes, maybe used to treat skin diseases. Skin is the large organ that covers and
protects the body.
Skin serves a variety of purposes. • It helps to keep fluid in the body and prevent dehydration.•
This assists in sensing sensations such as temperature and pain.• Keep bacteria, viruses, and other
infection-causing organisms outside.• It helps to maintain a constant body temperature.
In response to sun exposure, vitamin D is synthesized. All conditions that clog, irritate, or inflame
the skin are considered skin diseases. Rashes or other changes in the appearance of the skin are
common symptoms of skin diseases. Some skin diseases aren’t as serious as others. Others have
severe side effects. The following are some of the most common skin diseases:• Acne, clogged
skin follicles, and a build-up of oil, bacteria, and dead skin in the pores.• Alopecia areata is a
condition in which the patient lose hair in small patches.• Eczema (atopic dermatitis) is a dry, itchy
skin condition that causes swelling, cracking, and scaliness.• Psoriasis is a scaly skin condition in
which the patient’s skin swells and become hot.• Raynaud’s phenomenon is characterised by a
reduction in blood flow to the patient fingers, toes, or other body parts, resulting in numbness or a
change in skin colour. • Rosacea is characterised by flushed, thick skin and pimples, which usually
appear on the face.• Skin cancer is caused by the uncontrolled growth of abnormal skin cells.•
Vitiligo, patches of skin that lose pigment.
SUBJECTIVE: CHIEF COMPLAINT: Mr. XYZ arms have itchy patches of skin, and his
stomach has red, blister-like bumps.
HISTORY OF PRESENT ILLNESS: A 55-year-old male patient named Mr. XYZ went to the
clinic with pruritus, or dry, scaling plaques on the posterior of the forearms. The plaques began
“smaller a couple months ago” and have gradually grown in size, according to the patient. He
admits that the pruritus gets worse at times, but he says he doesn’t have any pain or other
symptoms. In addition, an over-the-counter lotion was applied to the affected areas, but the
symptoms were not alleviated. The patient also has some cherry red, discoid papules on his torso,
which he is concerned about. He explained that they had been there for years, but one became
concerned when his pet dog jumped on him and scratched him with nails. He denies that the
papules have any associated symptoms or exacerbating factors.
PAST MEDICAL HISTORY: Medical:1. Hypertension: diagnosed at age 45 and still
hypertensive.2. Coronary artery disease: diagnosed at age 56. Surgical: Medications: 1. Aspirin
81mg PO daily.2. Simvastatin 20mg PO daily.3. Lisinopril 20 mg PO daily. Allergies: Penicillin
Causes a rash. Health maintenance: Mr. XYZ comes in for a routine physical exam once a year.
The most recent bloodwork was done at an annual exam two years ago. Immunizations: Mr. XYZ
immunizations are up to date, and his annual influenza vaccination is current as of March 2022.
FAMILY HISTORY: His father died of a heart attack at the age of 75, and mother is of 73 years
and suffers from hypertension and coronary artery disease. Mr. XYZ has no siblings and claims
that both of his daughters are healthy and have no medical history.
PSYCHOSOCIAL HISTORY: Mr. XYZ resides with his wife. Both the young ones tend to be
grown, hitched, and never reside in the house. Mr. XYZ has a master’s level and is a consultant
that is a bank business owner receiving health and healthy benefits through work. He states his
wife "is in in good health. He denies any concerns that are economic. He denies any utilisation of
cigarette services and products and the usage of alcoholic beverages or drugs for leisure. He
participates in regular exercise, having a gym membership where he “does the elliptical, lifts loads,
and makes use of the rowing machine.” Mr. XYZ additionally walks when he golfs “several times
per week,” carrying his bag, but reports a lifestyle that is certainly significantly inactive. He does
not have any dietary considerations and consumes a diet that is well-balanced and avoids
caffeinated drinks.
REVIEW OF SYSTEMS: General: No recent changes in weight and denies any fatigue, night
sweats, fever, or chills.
HEENT: Wears “cheaters” to read dinner menus with dim lighting and denies any double vision
or history of cataracts. No loss of hearing or changes in sense of smell, denies ear pain, nasal
drainage or chronic sinus infections. No dentures or appliances and stated that his last dental exam
was “about 6months ago.” Cardiovascular: Mr. XYZ denied any heart palpitations, chest pain,
palpitations, or dyspnoea, No history of arrhythmias or murmurs. No history of Electrocardiogram
(ECG).
Genitourinary: He denies hesitancy with urination, haematuria, incontinence, penile discharge, or
erectile dysfunction. He has never had a Prostate-Specific Antigen (PSA) Test. Integumentary:
Mr. XYZ complains about the pruritis of the scaly plaques on his arms and is concerned about the
cherry red papules also. He denies any other rashes, pruritis, or bruising. No history of skin cancer
or other lesions has been observed.
OBJECTIVE:
PHYSICAL EXAMINATION General: Mr. XYZ is a well-groomed caucasian male of well
nutritional status who is cooperative and answers questions appropriately. He is alert and oriented.
Vital signs: Temperature 98.4 °F, Blood Pressure: 134/80 mm Hg, Pulse: 70 beats per minute,
Respiratory Rate: 18 breaths per minute. weighs :86 Kg Height: 5’10” BMI: 26.69.
Skin: Dry, scaly, red coloured plaques are present on the posterior aspects of both forearms. Cherry
red discoid papules are present on torso. Skin surrounding the lesions is normal in appearance
without redness or edema. Skin turgor is normal with no pallor or jaundice.
HEENT: normocephalic, PERRLA Neck: supple, full ROM. No JVD or bruit.
Chest/Lungs: Breath sounds clear and regular bilaterally.
Cardiovascular System: Heart regular rate and rhythm. No murmurs. Distal pulses 2+. No
peripheral edema.
Abdomen: Soft, nontender. No distention, masses, or organomegaly. Normoactive bowel sounds.
Genital/rectal: External genitalia reveals circumcised male with normally descended testes.
Prostate is non-tender and not enlarged.
Musculoskeletal system: Fully weight-bearing. Full ROM in all extremities.
Neurological: A&O x3, cooperative. CN II-XII intact. DTRs 2+ and symmetrical bilaterally.
ASSESSMENT: Differential diagnosis 1. Psoriasis 2. Seborrheic dermatitis 3. Atopic dermatitis
4. Tinea Corpis
Differential diagnosis 1. Cherry angioma 2. Angiokeratoma 3. Keratosis pilaris
PLAN: Psoriasis will be treated for this diagnosis. Psoriasis is characterised by scaling papules
that are circumscribed, dry, silvery, salmon-coloured, and occur frequently on the back, buttocks,
exterior services of extremities, and scalp. Cherry angiomas will be treated for this diagnosis. This
explains why cherry angiomas are characterised by small, bright ruby-red, round papules that can
be found in almost everyone over the age of 30 and become more common as they get older.
 Experiment No. 16
OBJECT: To counsel the patients suffering from hypertension (a hypothetical case study)
REFERENCE: Singh Harpreet, Mishra A.K, Chaudhary V.K, Laboratory Manual of
Pharmacotherapeutics, Everest Publishing House, 1st Edition 2023, Page No. 84-87.
Theory: Patient counselling is the process of providing vital information, advices and assistance
to patients in order to help them with their medications and ensuret hat they are taken in correct
way. Important details about the patient’s illness and lifestyle are also included. A patient is
advised on whether to take medications with or without food, at bedtime or in the morning, with
water, juice, or milk, whether to swallow the tablet whole or chew it, and how long to wait between
doses. As a result, all of this information, the medications are used correctly and have the best
therapeutic effect possible.
Counselling to hypertensive patients requires insight, creativity, and ingenuity, because fixed
messages will fall flat and will remain. Effective counselling, on the other hand, focuses on three
important themes: improving health status through adherence, providing information on side
effects and contraindications and encourages the healthy behaviours. To save time and to identify
information gaps quickly, always start by asking patients what their prescribers told them
previously.
DISEASE CONDITION: Mr. Ram Singh, age 59 years, is suffering from hypertension from last
19 years. Regularly his blood pressure is in the range of 180/110 mm Hg.
COUNSELLING ON MEDICATIONS: The following drugs are prescribed to Mr. Singh -:
TAB AMLODIPINE 5/10 mg; TAB ATENOLOL 50 mg; TAB FUROSEMIDE 2-6mg/day; NO
SALT DIET.
COUNSELLING ON LIFESTYLE MODIFICATIONS: Following lifestyle modifications are
recommended to Mr. Singh
• Avoid alcohol intake
• Stop smoking.
• Caffeine consumption should be reduced.
• Cut stress levels.
• Lose weight and keep an eye on waistline.
• Exercise on a regular basis.
• Maintain a balanced diet.
• Reduce the sodium intake.
COUNSELLING ON MONITORING PARAMETERS:
Regular Blood Pressure Check-up at home: Mr. Singh should check his blood pressure at home
on a regular basis to learn more about his condition and confirm whether he has high blood
pressure. Home monitoring is an important tool for confirming whether or not someone has high
blood pressure, determining whether or not their blood pressure treatment is working, and
diagnosing high blood pressure that is getting worse. Blood pressure monitors for home use are
inexpensive and widely available. Blood pressure monitoring at home isn’t a substitute for doctor
visits, and some monitors have limitations. Make sure of using a reliable device and that the cuff
fits properly. Bring the monitor to the doctor’s clinic once a year to have it checked for accuracy.
Consult the doctor to learn how to start monitoring the blood pressure at home.
Laboratory Tests: The following laboratorytests are advised to Mr. Singh -:
Blood pressure monitoring test- This 24-hour blood pressure monitoring test determines
whether or not a person has high blood pressure. This test’s device takes blood pressure readings
at regular intervals over a 24-hour period, giving a more accurate representation of blood pressure
changes throughout the day and night. These devices, however, are not available in all medical
centres, and they may not be covered by insurance.
Electrocardiogram- The electrical activity of the heart is measured in this quick and painless test.
Echocardiogram- The doctor may an echocardiogram to check for more signs of heart disease
based on the signs and symptoms and test results. Soundwaves are used to create images of the
heart in an echocardiogram.
 Experiment No. 17
OBJECT: To counsel the patients suffering from diabetes (a hypothetical case study)
REFERENCE: Singh Harpreet, Mishra A.K, Chaudhary V.K, Laboratory Manual of
Pharmacotherapeutics, Everest Publishing House, 1st Edition 2023, 88-92.
Theory: Patient counselling allows to gather the necessary information from a patient for the safe
and effective use of medications. Patients have the right to expect confidential medication advice
from pharmacists. Counselling is also the final step in ensuring that the appropriate medicine is
administered to the appropriate patient. Over the last three decades, the pharmacist’s role has
evolved dramatically. Pharmacists are increasingly focusing on the patient rather than the product.
Through patient counselling, pharmacists provide patients with information about their diseases,
medications, and lifestyle changes. It has been demonstrated that it improves therapeutic outcomes.
Diabetes Mellitus, a group of metabolic disorders, is characterised by hyperglycemia and abnormal
carbohydrate, fat, and protein metabolism. Chronic complications can result in microvascular,
macrovascular, and neuropathic disorders. In diabetes, patient self-management and adherence to
prescribed medication and lifestyle changes are critical, and pharmacists can assist with
counselling. The counselling plan should include both non-pharmacological and pharmacological
interventions. It’s crucial to educate people about acute and chronic complications. There is strong
evidence that pharmacist-provided counselling improves diabetes patient compliance and quality
of life outcomes.
DISEASE CONDITION: Mr. Mohan, age 56 years is suffering from Type II Diabetes Mellitus
from last 5 years.
COUNSELLING ON MEDICATIONS: The following drugs are prescribed to Mr. Mohan-TAB
METFORMIN – 250 – 500 mg to 1gm
TAB GLIMEPIRIDE – 1 – 2 mg
TAB NETAGLINIDE- 60 mg/day
COUNSELLING ON LIFESTYLE MODIFICATIONS: Following lifestyle modifications are
recommended-: 1. Limit carbohydrate servings. Sugar, starch, and fibre are all types of
carbohydrates. Several studies show that carbohydrates, regardless of their source (cakes, corn,
cereal, or candy), produce a similar blood sugar response. Thus, the total amount of carbohydrates
in meals and snacks, not the type of carbohydrate, is the most important factor to take into account.
2. Maintain approximately the same number of carbohydrate servings at each meal each
day. This is especially critical if the patient is on a fixed insulin dose. Many people who use insulin
can adjust their dosage based on the amount of carbohydrates they plan to eat and their current
blood sugar level. Patients should not attempt this without first receiving education and coaching.3.
Lose weight. Weight loss lowers blood sugar levels and can be so effective that some patients can
stop taking their diabetes medications once they reach their weight-loss goals. Low-carbohydrate
diets promote weight loss by substituting monounsaturated fat for carbohydrates. Although this
lowers postprandial blood sugars and triglycerides, there is some concern that the increased fat
consumption could lead to weight gain. The best weight-loss programmes include regular exercise,
which is defined as exercising for at least 30 minutes on most days of the week. Before beginning
an exercise programme, all diabetic patients should consult with their doctor.4. Restrict protein
in the case of renal dysfunction. If renal function is normal, there is no evidence to suggest that
normal protein intake (15% to 20% of total daily energy) should be changed for people with
diabetes. Protein should be limited to 8 mg/kg/day if renal dysfunction is present. 5. Limit sodium.
In people with diabetes, hypertension raises the risk of heart attack, stroke, and nephropathy.
Limiting sodium in the diet can help to lower the blood pressure. Reduce sodium intake to 2400
mg or salt intake to 6000 mg per day. 6. Limit saturated fats and dietary cholesterol.
Dyslipidaemia, like diabetes, raises a person’s risk of cardiovascular problems "like heart attack
and stroke. Saturated fats should account for 10% of daily calories. Cholesterol intake should be
kept to under 300 mg/dL per day. 7. Limit alcohol consumption. It’s critical to inform diabetic
patients who want to drink alcohol when and how much they can drink while still keeping their
diabetes under control. When combined with oral diabetes medications or insulin, alcohol can
cause significant blood sugar fluctuations. By releasing glucose into the bloodstream, the liver
normally prevents a person’s blood sugar from falling too low. Because the liver is breaking down
the alcohol when a person drinks, it is unable to maintain this action. As a result, if a diabetic takes
insulin and drinks alcohol, his or her blood sugar may drop dangerously low.
COUNSELLING ON MONITORING PARAMETERS: A blood test every three months,
blood tests every day, and a system that constantly monitors the blood glucose level are three tools
that can help manage diabetes. The three-month blood test is called an A1C test. This test reflects
the blood sugar (or blood glucose) control over the past 2-3 months. Testing the A1C level every
3 months is the best way for the patient and the doctor to understand how well the blood sugar
levels are controlled. The doctor will likely be the one who will write to have an A1C test.
However, the patient can also purchase over-the-counter A1C testing kits that one can use at home.
The daily blood test is done with a blood glucose monitor (BGM). This is also called a home blood
sugar meter, a glucometer, or a glucose meter. This type of testing is often referred to as self-
monitoring of blood glucose. The doctor may prescribe a BGM, especially if the blood sugar
fluctuates. A BGM is a test that determines the amount of glucose in a drop of blood at a specific
time. This tried-and-true test involves taking a sample of the patient’s blood, which is usually taken
from the finger. A fingerstick is the term for this procedure. Blood is drawn from the finger and
placed on a test strip, which is then read by a monitor. To get an accurate picture of the glucose
levels, finger sticks should be done several times a day, sometimes at night. Blood sugar control
can be improved with regular testing.
The third type of monitoring is with a continuous glucose monitoring system (CGM). This new
product allows diabetics to monitor their blood glucose levels24 hours a day, seven days a week.
CGMs consist of a small, easy-to-insert sensor that the patient wears for 14 days. The sensor is
equipped with an adhesive that aids in its adhesion to the patient’s skin. A transmitter is also
included in the CGM. This could be a separate device or integrated into the sensor. Some CGMs
are designed to last longer than 14 days, but they must be implanted under the patient’s skin by a
physician.
A receiver or reader is also included with a CGM. This allows the data from the transmitter to be
received by the computer or smartphone. The information provided by the data provides detailed
insights and trends on the patient’s blood glucose levels throughout the day. It can predict
dangerous highs and lows based on this information. This can assist in making quick, day-to-day
adjustments in order to remain in the targeted area. Changes in eating habits and exercise levels
are two examples of adjustments. Additionally, this information can assist the patient and doctor
in making diabetes management decisions.
 Experiment No. 18
OBJECT: To counsel the patients suffering from asthma (a hypothetical case study)
REFERENCE: Singh Harpreet, Mishra A.K, Chaudhary V.K, Laboratory Manual of
Pharmacotherapeutics, Everest Publishing House, 1st Edition 2023, Page No. 93-97.
Theory: By educating patients about asthma triggers and how to avoid them, pharmacists can play
an important role in preventing asthma exacerbations. Many asthma patients are unaware of
common triggers, and as a result, they may unwittingly be exposed to factors that aggravate their
symptoms. Pharmacists can help patients better control their asthma by educating them on how to
avoid triggers. Most asthmatic children develop symptoms before the age of 5 years. Two-thirds
of asthma sufferers are diagnosed before the age of 18 years. Among youth aged 7 to 17 years,
concurrent mental health issues (eg, depression, anxiety, behavioural disorders) are common. Both
anxiety and depression are linked to poorer asthma control. Family conflict also impacts asthma
severity, resulting in increased hospitalizations. Researchers believe a bidirectional causal
relationship exists. Living with asthma may induce anxiety and depression.
DISEASE CONDITION: Mr. Shyam, age 46 years is suffering from asthma from last 3 years.
COUNSELLING ON MEDICATIONS: The following medications are recommended to Mr.
Shyam-: Just take precaution med. Like inhaler (salbutamol) longer acting inhaler(formoterol).
TAB DERIPHYLINE 150mg
BDINJ AMINOPHYLLINE: 15-20 mg/day
TAB DOXOPHYLLINE: 6mg twice a day
TAB MONTELUKAST: 4-10mg/dose
SALBUTAMAOL: 0.1-0.4 mg
INHALER: 100-400 mg
THEOPHYLLIN: 15-25mg, LOADING DOSE- 6-10 mg
COUNSELLING ON LIFESTYLE MODIFICATIONS: Patients, or the parents of a child,
must be actively involved in their own self-management. For asthma self-management, the asthma
action plan is essential. It explains how to take medication correctly and how to use a peak air flow
metre, as well as how to identify known triggers and what to do if symptoms worsen. The asthma
action plan also includes instructions on how to measure and interpret peak air flow. Asthma is
considered well controlled if the peak air flow is 80% or higher. If the patient’s peak air flow is
between 50% and 70%, the asthma isn’t under control. If peak air flow falls below 50%, it is a
medical emergency, and patients should contact their doctor or immediately. A stepdown
medication adjustment is appropriate for patients who have had good asthma control for at least
three months.
COUNSELLING ON MONITORING PARAMETERS: Asthma is a chronic inflammatory
disease of the lungs marked by airway hyperresponsiveness to physical, chemical, and
pharmacological stimuli. Bronchial obstruction results from the inflammatory response, which can
range in severity from mild shortness of breath to fatal airway obstruction. Inflammation, asthmatic
symptoms, and the need for medications can all be reduced by avoiding substances that can cause
asthma exacerbations. Pharmacists can assist patients in managing their asthma by educating them
about potential asthma triggers and how to avoid them. Asthma triggers are anything that can cause
an asthma attack. They can be classified into following categories: • Inhalant allergens. • Irritants.
• Occupational exposures.
Identifying asthma triggers is the first step to avoiding them. Patients with asthma should have
their exposure to potential triggers evaluated, and they should be advised to avoid triggers that
aggravate their asthma symptoms.
Inhalant Allergens: The most common source of indoor allergenic material is dust mites. It’s
aswarm of microscopic mites. Mattresses, pillows, bedding, carpets, upholstered furniture,
clothing, and stuffed animals are all common places to find them. The patient should be instructed
to cover the mattress and pillows in allergen-impermeable covers to help control dust mite
exposure. Bedding and stuffed animals should be washed in hot water on a weekly basis. If at all
possible, carpeting should be removed from the bedroom or at the very least vacuumed frequently
with a vacuum with a high-efficiency particulate air filter.
"Allergenic materials are also commonly found in pets. All warm-blooded animals produce
dander, saliva, urine, and faeces, which can trigger an allergic reaction in susceptible individuals.
The best way to avoid allergens is to remove the offending pet, but this is often not an option for
the owner. Pet lovers have the option of keeping their pets out of the bedroom and away from
carpets and upholstered furniture, which can harbour allergens. Another asthma trigger could be
cockroaches. Cockroach droppings and body parts have been shown to trigger asthma attacks in
asthmatic patients. Patients should be reminded not to leave food or garbage out in the open and
to clean their dishes, sinks, tables, and floors. If necessary, bait or traps can be set, or an
exterminator can be hired. Mold in the home can also be an asthma trigger. The patient should be
advised to use a dehumidifier to reduce moisture in the home in order to reduce exposure. Outdoor
allergens could be the source of asthma symptoms that appear only at certain times of the year.
Pollen and outdoor mould exposure can be reduced by closing windows and staying inside on days
with high pollen counts.
Allergens aren’t found in all asthma triggers. Triggers such as smoke, air pollution, and strong
odours can be classified as irritants. Cigarette smoke can set off an asthma attack and have a
negative impact on one’s overall health. Patients who smoke should be encouraged to give up the
habit. Patients who do not smoke should be advised to avoid situations where smoking occurs and
to prohibit smoking in their homes. Asthma can be aggravated by both outdoor and indoor air
pollution. Patients who live in polluted cities should be advised to keep their windows shut and
stay indoors on days when smog levels are high. Wood-burning stoves, fireplaces, and kerosene
heaters can all contribute to indoor pollution.
Occupational Exposures: In the workplace, patients may be exposed to a variety of triggers,
including dust, chemicals, and plant or animal products. If patients’ symptoms improve after being
away from work for several days, occupational asthma may be suspected. In such cases, workplace
issues such as avoidance, ventilation, and respiratory protection must be addressed.
Other Factors: Patients may be unaware that a variety of other factors can set off an asthma attack.
Because inflammation of the upper airways has been linked to lower airway hyperresponsiveness,
patients with seasonal allergic rhinitis may be at an increased risk of asthma attacks. Intranasal
corticosteroids may be helpful in "the treatment of these patients. Asthma symptoms can be
exacerbated by colds and other illnesses. Patients should be reminded to wash their hands
frequently and get an annual flu shot.
Gastroesophageal (GERD) reflux disease is another factor that can aggravate asthma. Controlling
GERD symptoms has been linked to a reduction in asthma symptoms. Patients with GERD should
talk to their pharmacists about making lifestyle changes to help them feel better. Pharmacological
treatment may also be required.
Asthma attacks have been linked to certain foods. Patients with food sensitivities should be aware
of the ingredients in everything they eat. Another factor that can aggravate asthma is cold air. On
very cold, windy days, patients should beadvised to stay inside and use a scarf to cover their mouth
if they must go out. Asthma is commonly triggered by physical activity. Warming up before
exercising and, if necessary, pre-treating with an albuterol inhaler prior to exercise can help
patients reduce their symptoms.
 Experiment No. 19
OBJECT: To counsel the patients suffering from depression (a hypothetical case study)
REFERENCE: Singh Harpreet, Mishra A.K, Chaudhary V.K, Laboratory Manual of
Pharmacotherapeutics, Everest Publishing House, 1st Edition 2023, Page No. 98-101.
Theory: Depression is a serious mental illness. It can have an impact on how someone thinks,
feels, interacts with others, and goes about their daily lives. It can lead to sadness and a loss of
interest or pleasure in previously enjoyed activities. Anyone can be affected by depression, and it
can strike at any age, though it most commonly strikes adults. The good news is that depression is
highly treatable, with estimates ranging from 80–90% of people responding well to treatment.
Depression responds well to treatment for a variety of reasons, one of which is that improvements
can be found by medications, psychotherapy, or a combination of the two. Finding the right
psychotherapist to help the patient understand and work through the underlying causes of
depression, as well as develop coping strategies to deal with the symptoms, is frequently the first
step toward feeling better.
DISEASE CONDITION: “I came to the hospital after having suicidal thoughts and ideas about
drowning and/or hanging myself,” says the 37-year-old patient. The patient expresses loneliness
and has been attempting to manage his depression for the past two years. The patient claims that
the sadness and void he feels is the most troubling aspect of his depression. The patient claims that
his depression usually lasts for a while before taking over and making him want to commit suicide,
but he “doesn’t want to be sad anymore.”
COUNSELLING ON MEDICATIONS: The following drugs are prescribed to the patient-
AMITRIPTYLLINE HCL: 1-5 mg/day.
TAB CHLORDIAZEPOXIDE: 0.3-0.5 mg/day.
TAKE SSRIs (Selective serotonin reuptake inhibitors).
TAB CITALOPRAM: 10 mg/day.
TAB SERTRALINE: 50 mg/day.
TAB FLUOXETINE: 20 mg/day.T
AKE SNRIS (Serotonin and norepinephrine reuptake inhibitors).
TAB DULOXETINE: 60 mg/day.
COUNSELLING ON LIFESTYLE MODIFICATIONS: When it comes to mild to moderate
depression, “talk therapy” is frequently the first step. Many experts will use this method before
attempting medication. If the depression is more severe, the patient may need both therapy and
medication at the same time. It’s critical to understand the differences between counselling and
psychotherapy before moving forward. The terms “counselling” and “psychotherapy” are
frequently used interchangeably. While the two are very similar, it’s important to remember that
psychotherapy with a psychiatrist is sometimes regarded as a more long-term approach that focuses
on depression and deeper issues that are having a significant impact on the patient’s life.
Counselling, on the other hand, is more commonly thought of as a short-term treatment that focuses
on mild to moderate symptoms as well as outward functioning and behaviour.
COUNSELLING FOR MONITORING PARAMETERS: The type of therapy is often
determined by the length and severity of the symptoms and episodes of depression. Working with
a psychiatrist or psychologist may be necessary if the patient has been depressed for a long time
and their symptoms are severe, as they deal with issues from the past that may be deeply rooted in
their current feelings. Working with a therapist in a counselling may be beneficial if the symptoms
of depression are newer or less severe. During counselling, the therapist will use “talk therapy” to
assist the patient in understanding and working through the issues that are negatively impacting
his or her life. The therapist job is to listen, provide feedback, and collaborate with the patient on
strategy development. He or She will also assess how far they’ve come and adjust the sessions
accordingly. The patient may be assigned homework to supplement the information learned during
counselling sessions. This is frequently done by keeping track of one’s moods and feelings.
The therapist can use cognitive behaviour therapy to help the patient change negative thinking
patterns that may be exacerbating depression symptoms. The focus is on achieving a specific goal
with the patient playing an active role. Because cognitive behaviour therapy is typically thought
of as a short-term treatment, it’s a popular choice among therapists when dealing with mild to
moderate depression that doesn’t require long-term, in-depth psychotherapy.
According to research, cognitive behaviour therapy appears to be effective in the treatment of
depression. It’s also been shown to lower the rate of relapse or recurrence of depression after
counselling has ended. Interpersonal therapy (IPT) is a brief or short-term method of depression
counselling that focuses on interpersonal conflict and a lack of social support, both of which can
contribute to depression. This type of therapy can help the patient communicate more effectively
and address issues that exacerbate depression symptoms. According to research, IPT appears to be
effective in the acute treatment of depression and may also help prevent new depressive disorders.
 Experiment No. 20
OBJECT: To counsel the patients suffering from stroke (a hypothetical case study)
REFERENCE: Singh Harpreet, Mishra A.K, Chaudhary V.K, Laboratory Manual of
Pharmacotherapeutics, Everest Publishing House, 1st Edition 2023, Page No. 102-105.
Theory: Despite the fact that the word “stroke” is centuries old, the World Health Organization
defined it in the 1970s as a “neurological deficit of cerebrovascular origin that persists beyond 24
hours or is interrupted by death within 24 hours.” A stroke is a medical condition in which the
brain’s blood supply is disrupted ,resulting in cell death. Ischemic stroke is caused by a lack of
blood flow, while hemorrhagic stroke is caused by bleeding. Both of these conditions cause parts
of the brain to stop working properly. Inability to move or feel on one side of the body, problems
understanding or speaking, dizziness, or loss of vision on one side are all signs and symptoms of
a stroke. Symptoms and signs of a stroke often appear soon after the event. A transient ischemic
attack (TIA), also known as a mini-stroke, occurs when symptoms last less than one or two hours.
A severe headache is often accompanied by a hemorrhagic stroke. A stroke’s symptoms can last a
lifetime. Pneumonia and a loss of bladder control are two long-term complications that can occur.
DISEASE CONDITION: The 60-year-old patient reported to the doctor’s clinic today
complaining of his blood pressure being high and that a week ago, he had an episode of stroke.
COUNSELLING ON MEDICATIONS: The following drugs are recommended-
TAB NITROGLYCRINE
ANGIOTENSIN CONVERTING ENZYME AND ANTI COAUGULANT MED.
DOPAMINE – 2-20 mg/kg/min Infusion rate: 6 * WT (kg) * desired dose/mg/100 ml of IV fluid.
COUNSELLING ON LIFESTYLE MODIFICATIONS: Lifestyle changes that can reduce the
risk of stroke include:
High blood pressure- High blood pressure patients are four to six times more likely to have a
stroke. It is the single most important factor in both men’s and women’s stroke risk. High blood
pressure affects one out of every three adults. Check your pressure on a regular basis, and if it’s
high, keep an eye on it. High blood pressure can be reduced by reducing salt intake, avoiding high-
cholesterol foods, increasing exercise, and quitting smoking.
Exercise- Working out helps to keep the blood flowing and the heart healthy. Set a goal of 30
minutes of exercise five days a week. Even 10 minutes of exercise is beneficial for health.
Diet- Eat diet rich in fish and fruits—had the lowest stroke risk. Consume a variety of fruits,
vegetables, whole grains, and lean proteins.
Smoking- Tobacco in any form can cause blockages in the artery that leads to the brain. Nicotine
also increases the amount of plaque build-up in the arteries by raising blood pressure and
thickening the blood. When a person quits smoking, his or her risk of stroke immediately
decreases.
Obesity- Obesity is linked to high blood pressure, high cholesterol, diabetes, and heart disease.
Balance out the amount of calories consumed. Even a small weight loss of ten pounds can have a
significant impact on stroke risk.
COUNSELLING ON MONITORING PARAMETERS
1. Speech Therapy Stroke survivors may have trouble speaking, finding words, or understanding
what other people are saying. This is called aphasia. Speech-language pathologists help people
with aphasia relearn how to use language and communicate. Therapy may include repeating words
as well as reading and writing exercises.
2. Physical Therapy Stroke can cause problems with movement. Paralysis, or loss of muscle
function, is common after stroke — especially on one side of the body. Physical therapy can help
stroke survivors regain strength, coordination, balance, and control of movement.
3. Occupational Therapy Occupational therapists or rehabilitation nurses can help stroke survivors
relearn some of the skills they will need to care for themselves after a stroke. Rehabilitation nurses
may help stroke survivors manage their personal care, such as bathing and washing. They can also
help with therapy to regain continence (control of bladder and bowel movements) after a stroke.
Occupational therapists may help stroke survivors relearn how to do activities such as preparing
meals, cleaning the house, and driving.
4. Psychological Counselling Stroke can cause chemical changes in the brain that affect the way a
person thinks, feels, and behaves. At the same time, stroke rehabilitation can be a long and difficult
process. Even after rehabilitation is complete, most stroke survivors will live with some minor to
moderate disabilities. Many stroke survivors will require mental health counselling and medication
to help address issues such as depression, anxiety, frustration, and anger. It’s important to identify
and treat mental health issues, such as depression, early in the recovery process. Stroke survivors
that are depressed may be less likely to follow through with stroke rehabilitation and treatment
plans.
 Experiment No. 21
OBJECT: To discuss the simulated cases to enable dose calculation of selected drugs in
paediatrics, and geriatrics under various pathological conditions.
REFERENCE: Singh Harpreet, Mishra A.K, Chaudhary V.K, Laboratory Manual of
Pharmacotherapeutics, Everest Publishing House, 1st Edition 2023, Page No. 106-114.
Theory: Simulation isn’t just a cutting-edge method of health-care education. It is becoming
standard practice, and national medical and other organisations have already recognised it as a
valuable teaching and assessment tool comparable to direct patient care experience. In a virtual
environment, simulation is used to safely test change. Simulation insight is used by healthcare
organisations to make better decisions that reduce risk to patients, staff and financial investment.
Simulation creates a situation or environment in which people can experience a simulation of a
real-life healthcare event for the purposes of practice, learning, evaluation, testing, or gaining a
better understanding of systems or human actions. To put it another way, simulation brings an
experimental situation as close as possible to reality. Several studies have shown the positive
impact of using simulation in the training of pharmacy students and pharmacists to improve
technical skills (medicines reconciliation, medical emergencies, order verification) and non-
technical skills (communication, attitude, empathy). The above competencies mainly concern
clinical pharmacists and their relationships with patients. It is hard to find simulation-based
training dedicated to pharmacists working in pharmaceutical technologies, especially in hospital.
Before touching patients, researchers and practitioners can test new clinical processes and improve
individual and team skills in a safe learning environment created by simulation in health care.
Before treating patients, clinicians can practice or become skilled in a technique using simulation.
Mannequins, standardized patients (actors), part-task trainers, and virtual reality are just a few
examples of simulation. Simulating a response to a specific threat can aid in the identification of
gaps in care processes as well as improve individual and team performance. Simulation has grown
in importance as a strategy for understanding and predicting pathophysiology, disease genesis, and
disease spread in support of clinical and policy decisions.
Posology (from the Greek posos, which means “how much” and logos, which means “science”) is
the science of doses. Because the optimum drug dose to achieve the desired therapeutic effect
differs from person to person, drug doses are usually expressed as a range. The prescribed dose
has a therapeutic effect in the majority of subjects and should be the lowest dose possible to elicit
the desired therapeutic response, while the maximum dose is the highest that an average subject
can tolerate. The official dose listed in the pharmacopoeia’s monographs is the average range of
quantities of that particular drug given orally to an adult within 24 hours. Drugs are rarely given
in their pure form; instead, they are given in the form of dosage forms. The dose of a particular
dosage form should be the same as the pure drug dose. For example, the paediatric and adult doses
of paracetamol are 125 mg and 500 mg, respectively, three times a day. As a result, the adult and
paediatric doses are 1 tablet or 5 mL of liquid three times per day, respectively. Pharmacotherapy
in the elderly requires an understanding of the age-dependent changes in function and composition
of the body. Aging is characterized by a progressive loss of functional capacities of most if not all
organs, a reduction in response to receptor stimulation and homeostatic mechanisms, and a loss of
water content and an increase of fat content in the body. The most important pharmacokinetic
change in old age is a decrease in the excretory capacity of the kidney; in this regard, the elderly
should be considered as renally insufficient patients. The decline in the rate of drug metabolism
with advancing age is less marked. In addition, the volume of distribution and the oral
bioavailability of drugs may be changed in the elderly compared with younger individuals. The
term “elderly” is subject to varying definitions with regard to chronologic age, The functional
capacities of most organ systems decline throughout adulthood and important changes in drug
response occur with advancing age. Geriatric medicine or geriatrics is the field that encompasses
the management of illness disability in the elderly. Special considerations in dose determinations
for elderly patients therapy is initiated with a lower-than-usual adult dose, dose adjustment may
be based on the therapeutic response, the patient’s physical condition may determine the "drug
dose and the route of administration employed. The dose may be determined, in part, on the basis
of patient’s weight, body surface area, health and disease status, and pharmacokinetic factors.
Concomitant drug therapy may affect drug/dose effectiveness.
FACTORS THAT INFLUENCE THE DOSE OF A DRUG
Age- Children may not react to all drugs in the same fashion as adults and with a few exception
drugs are more active and more toxic in children than in adults. This is due to many factors which
differ from adults, for example, in the new born infant the relative high total body water content,
the low bodyfat content, immature renal and hepatic function, altered protein binding and alteration
in gastric acidity. But in some cases activity of certain metabolic pathways such as conjugation
and oxidation in children, may actually exceed adult values and necessitate the administration of
high doses on mg/kg basis than those required to adults; e.g. in case of Theophylline. In old people,
the metabolism of drugs may diminish and many functions decline with age, requires different
dose than adults. Thus, with some exceptions drug tend to produce greater and more prolonged
effects at the extremities of life.
Body Weight and Surface Area- The relative proportion of muscular and adipose tissue in
individuals may be sufficient to alter the distribution and clearance of a drug from the body.
Therefore, dose for children is usually calculated on body weight basis in terms of mg/kg/day.
Many physiological factors such as plasma volume, oxygen consumption, and requirement of body
fluid electrolytes, calories and glomerular filtration are proportional to the surface area. The
surface area used to calculate dose, for example, anticancer drug methotrexate is administered on
mg per sq.m. of body surface.
Sex- Response to drug as per sex difference may be due to unequal ratio of lean body mass to fat
mass. On the basis of weight female adults generally require smaller doses than males. The adult
females have greater percentage of adipose tissue and smaller water percentage of total body
weight than in the adult male. Secondly, drugs should be administered with caution in pregnancy
and during lactation period.
Disease Condition- Antipyretics cause a fall in body temperature in an individual with fever, but
if the same dose is given to a person whose temperature is normal, no noticeable effect is observed.
Secondly, because of pathological conditions like renal function impairment or liver disease many
drugs remain in body for longer period of time, reducing the dose required.
Route of Administration- Whether the drug is administered orally, rectally or by injection
determines effectiveness of its action. Dose varies according to rate and extent of drug absorption
when administered by these different routes. The "effect of drug is more by injection than oral
route. The intravenous dose of a drug is often smaller than the subcutaneous route and this in turn
is smaller than the oral dose.
Time of Administration- Absorption proceeds more rapidly if the stomach and upper portion of
the intestinal tract are empty. Thus, any change in gastrointestinal emptying rate is likely to affect
the dose. Number of drugs require more dose if given after a meal, for example, ferrous sulphate
if administered in between meals is more effective than the effect produced by same dose
administered after meals. several physiological functions are altered during bed rest as compared
to the upright position, including reduction in gastric emptying rate, increase in cardiac output and
renal flow. The blood pressure and heart attacks are more in early morning; acidity begins from4
pm till night 12 pm, these time periods need more dose than any other time of a day.
Frequency of Administration- The drugs with short plasma half-life have high rate of clearance
and requires frequent dosing to maintain steady state plasma concentration. Controlled drug
delivery systems are also developed to reduce the frequency of administration.
Tolerance- Tolerance is a diminished response as the use of the drug continues. If tolerance
occurs, large dose of a drug is required to elicit an effect that is ordinarily produced by the normal
therapeutic dose of the drug. Examples of drugs which may produce tolerance after chronic
administration are narcotic drugs like morphine, pethidine, heroin, barbiturates, amphetamine,
caffeine and nicotine etc.
Idiosyncrasy and Hypersensitivity- Idiosyncrasy is defined as a genetically determined abnormal
or unusual response to drug, that occurs in small proportion of individuals. For example,
“salicylism” produced by chronic dosing of aspirin. Hypersensitivity or drug allergy is an adverse
reaction to particular chemicals resulting from a previous exposure to the substance, occurring in
only a small fraction of all people receiving the particular drug. Most common allergic effects are
skin rashes, oedema, anaphylactic shock, bronchospasm, serum sickness syndrome, etc. and
examples of drug which may produce it are penicillin, sulphonamide, phenacetin etc.
Tachyphylaxis- The repetition of a particular drug if leads to decreased pharmacological response
then it is caned tachyphylaxis. The decreased response cannot be reversed by increasing the dose.
For example, response to repetitively administered ephedrine bronchial asthma.
Drug Interactions- When different drugs interact amongst themselves or with food in the body
it is called drug interaction. Acute administration of alcohol has been shown to reduce the clearance
of drugs like diazepam, paracetamol and "tolbutamide. The intake of coffee has been shown to
increase the bioavailability of paracetamol. Thus, in such cases amount of drug required will be
less. On the other hand, smoker may require an increased dose of theophylline to maintain
therapeutic plasma level.
DOSE CALCULATION
I. According to Age
a. Young’s Formula: Child Dose = Age (Years) × Adult dose / (Age+12) This formula is used to
calculate dose of child below 12 years of age.
CASE I: Ram is suffering from fever. The age of Ram is 45. Physician prescribed him paracetamol
500 mg. His son Aman who is 4 years old is also suffering from fever. Then, the dose of
paracetamol in mg required to treat aman can be calculated using young’s formula -:
Paracetamol Dose required to treat Aman = 4× 500=125 mg / (4+12)
The paracetamol liquid preparation for paediatric use is syrup or suspension:125 mg/5 ml; Kid
tablets: 125 mg. Adult tablet: 500 mg.
b. Dilling’s Formula: Child dose = Age (years) × Adult dose20
This formula is use to calculate dose for child with age of 4 to 20 years.
CASE II: Shyam is 46 years old. He was driving scooty on the road. His son Amar who is 10
years old was also with him. Suddenly the scooty slips and they both got external injury. He went
to a physician and doctor prescribed him amplicillin 250 – 500 mg 3 to 4 times/day. Then, the dose
of ampicillin in mg required to treat amar can be calculated using Dilling’s Formula:
Ampicillin dose required to treat amar-:
i.10/20×250=125 mg
ii. 10/20× 500 = 250 mg
Dispersible tablets for kid: Ampicillin 125 mg and 250 mg.
II. According to body weight
a. Clark’s formula: Child dose = weight (kg) × adult dose / 70
CASE III: Simar is 34 years old and her weight is 70 kg and She is suffering from headache.
Doctor prescribed her Nimesulide 100 mg b.i.d. His Son Sahib whose weight is 35 kg is also
suffering from headache. Then, the dose of nimesulide in mg required to treat sahib can be
calculated using Clark’s formula:
35/70 × 100=50 mg b.i.d
Nimesulide tablet 100 mg and suspension 50 mg/ 5 ml are available in the market.
CASE IV: Mr. Chaman is 65 years old. He is suffering from severe throat infection. Doctor first
prescribed him combination of Cefexime 200 mg/ Potassium Clavunate125 mg. After a day the
patient complained of loose motion. It might be due to age, The doctor re prescribed him Cefexime
200 mg alone.